Exam 3 - Questions Flashcards
(239 cards)
1
Q
Inhibits microtubule formation in bone cells and prevents neutrophil activation
A
Colchicine
2
Q
Can also be used for familial mediterranean fever and recurrent pericarditis (off-label)
A
Colchicine
3
Q
Contraindications for colchicine
A
Strong 3A4 inhibitors
Indinavir, ritonavir, ketoconazole, itraconazole, cobicistat, clarithromycin
4
Q
ADRs/Warnings for Colchicine
A
Diarrhea
Throat pain
Blood dyscrasias
Neuromuscular toxicity and rhabdomyolysis
5
Q
Neuromuscular toxicity and rhabdomyolysis and colchicine
A
Increased risk in elderly and with renal insufficiency
6
Q
Dose adjustment for colchicine
A
Renal insufficiency
7
Q
Dosing instructions for colchicine
A
2 tablets at first sign of flare, 1 tablet one hour later
8
Q
Xanthine oxidase inhibitor –> reduces production of uric acid
A
Allopurinol
Febuxostat
9
Q
Chemo patients are at risk of tumor lysis syndrome and hematologic malignancies with what medication?
A
Allopurinol
10
Q
Drug interactions with azathioprine, warfarin, theophylline
A
Allopurinol
May increase theophylline levels
11
Q
ADRs of allopurinol
A
Rash –> SJS
Diarrhea, nausea, increased LFTs, acute gout attack
12
Q
Drug that should be discontinued with first sign of rash
A
Allopurinol
Strong association with SJS
13
Q
Dose adjustment for allopurinol
A
Renal insufficiency
14
Q
Blocks renal tubular reabsorption of urate. Increases uric acid excretion, decreases serum urate levels
A
Probenecid
15
Q
Inhibits PCN secretion, increases PCN levels, can lead to seizure
A
Probenecid interaction
16
Q
Probenecid ADRs
A
Headache, nausea, worsening of gout flare, dizziness, uric acid, kidney stones, blood dyscrasias
17
Q
Febuxostat has a higher rate of ______ events than with allopurinol
A
CV
18
Q
Organ of concern with febuxostat
A
Liver - hepatic failure reported
Baseline LFTs and monitor during treatment
19
Q
Pegylated uricase enzyme. Catalyzes oxidation of uric acid to allantoin, which is easily excreted
A
Pegloticase
20
Q
Must be given in infusion center due to risk of anaphylaxis and infusion reaction. Patients require premed with antihistamines and corticosteroids
A
Pegloticase
21
Q
Pegloticase ADRs
A
Gout flare, infusion rxn, nausea, ecchymosis, nasopharyngitis, constipation, chest pain, vomiting, CHF exacerbation
22
Q
Recombinant urate-oxidase. Catalyzes enzyme oxidation of uric acid into allantoin
A
Rasburicase
23
Q
Rasburicase ADRs
A
Anaphylaxis, hemolysis, methemoglobinemia
24
Q
Indicated for use with an XOI when target uric acid levels are not achieved
A
Lesinurad
25
Lesinurad interactions
May reduce efficacy of amlodipine, sildenafil
26
ADRs of Lesinurad
Increased sCr, renal failure, kidney stones, HA, flu, GERD
27
Inhibit cytokine production, adhesion, protein activation, inflammatory cell migration and activation
Systemic Corticosteroids
| Prednisone, Methylprednisolone, Prednisolone
28
Systemic Corticosteroids Short Term Use ADRs
Hyperglycemia, increased appetite, fluid retention, weight gain, mood alteration, HTN, peptic ulcer
29
Systemic Corticosteroids Long Term Use ADRs
Adrenal axis suppression, growth suppression, thinning of skin, osteoporosis, HTN, diabetes, cushing's syndrome, impaired immune function
30
Inhibits dihydrofolate reductase, interferes with DNA synthesis, repair and replication
Methotrexate
31
First line for rheumatoid arthritis
Methotrexate
32
Organs to watch with Methotrexate
Liver and kidney
33
Indicated for rheumatoid arthritis, psoriasis and some cancers
Methotrexate
34
Contraindications to methotrexate
Pregnancy and lactation
Teratogenic
For male and female pts; wait until 3 months after last dose for men, one ovulatory cycle for women
ALSO: liver disease or alcoholism, blood dyscrasias
35
Methotrexate ADRs
N/V/D, hair loss, skin rash, abnormal liver enzymes, fatigue, mouth sores, low blood counts (increased risk of infxns)
36
Pyrimidine synthesis inhibitor; blocks enzyme that makes pyrimidines
Leflunomide
37
Leflunomide CI's
Pregnancy
| Baseline pregnancy test, drug elimination procedure upon discontinuation in women of childbearing potential
38
Organ of concern with Leflunomide
Liver
| Hepatotoxic --> monitor LFTs monthly x 6 months, then every 6-8 weeks
39
Leflunomide ADRs
Diarrhea, nausea, stomach pain, indigestion, rash, hair loss, abnormal LFTs, decreased blood cell or platelet counts
Rarely, cough, SOB or lung injury
40
Indicated for malaria tx and prophylaxis, rheumatoid arthritis, discoid and systemic lupus
Hydroxychloroquine
41
Hydroxychloroquine CI's
Retinal or visual field changes
| Long-term use in kids --> previously caused lots of problems
42
Hydroxychloroquine ADRs
Nausea, Diarrhea, skin and hair changes, rash, eye effects (bull's eye maculopathy)
43
Associated with Bull's Eye Maculopathy
Hydroxychloroquine
Edema, atrophy, and abnormal pigmentation of the macula
Baseline and annual eye exams recommended
44
Indicated for ulcerative colitis, rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis
Sulfasalazine
45
Sulfasalazine ADRs
Nausea, abdominal discomfort, photosensitivity
46
Instructions for sulfasalazine
Take with food and full glass of water to avoid abdominal discomfort
47
Used for mild rheumatoid arthritis. Not first line, but used when run out of options
Minocycline
48
Pt education for minocycline
SLOW ONSET
| 2-3 months to start working, one year for maximum benefits
49
Minocycline ADRs
GI, dizziness, rash, photosensitivity
50
Minocycline CI's
Pregnancy/Lactation
| Can slow down fetal development / teeth discoloration
51
Medications to avoid during pregnancy!
```
Methotrexate
Minocycline
Leflunomide
Teriparatide
Denosumab
Benzodiazepines
Lithium
```
52
Anti-TNF Drug Warnings
Increased risk of infection (TB testing prior to initiation)
HF CI (increased cardiac mortality)
Can worsen MS or cause MS-like symptoms
Increased risk of lymphoproliferative cancer!
53
Indicated for rheumatoid arthritis, juvenile arthritis, Crohn's colitis, ankylosing spondylitis and psoriasis
Anti-TNF Drugs
54
Anti-TNF Drug ADRs
Infection (upper respiratory, sinusitis, pharyngitis)
| Injection site rxns (rash, burning, itching), infusion related rxns (headache, abdominal pain)
55
Binds antigenic CD80/86 receptors, blocking interaction with T cell CD28
Abatacept
56
Abatacept CI's
Use with other biologics --> may worsen infections!
| Can cause COPD flares
57
Abatacept ADRs
HA, URI, nasopharyngitis, nausea
58
Targets and removes abnormal B cells, decreasing autoimmune response
Rituximab
59
Indicated for Non-Hodgkin's Lymphoma, Chronic Lymphocytic Leukemia, Wegener's Granulomatosis, Microscopic Polyangiitis
Second-line for RA
Rituximab
60
Rituximab Warnings
Tumor lysis syndrome, SJS/TEN, Hep B reactivation, cardiac arrhythmias, renal toxicity, bowel obstruction/perforation
61
Rituximab ADRs
```
Infusion reactions (premedicate with prednisone or dexamethasone, diphenhydramine)
Hypotension
```
62
Binds IL-6 receptors and inhibits IL-6 mediated signaling
Tocilizumab
63
Warnings for tocilizumab
Serious infections, GI perforation, neutropenia, live vaccines
64
Tocilizumab ADRs
Increased cholesterol, URI, nasopharyngitis, HA, hypertension, increased ALT
65
Indicated purely for psoriasis and psoriatic arthritis
Ustekinumab
66
Major cause of secondary osteoarthritis
Oral glucocorticoids
67
Treatment for vitamin D deficiency
D3 (cholecalciferol)
| D2 (ergocalciferol)
68
MOA: increase bone mass, reduce incidence of fractures by inhibiting osteoclast activity
Bisphosphonates
69
Bisphosphonate Precautions
Take on empty stomach and remain upright for 30-60 minutes
| Associated with pill induced esophagitis
70
Associated with pill induced esophagitis
Bisphosphonates
71
Bisphosphonates CI
Avoid in childbearing age
| Binds to bone for 10 years
72
Bisphosphonate Monitoring
```
DXA
Alk phos
Urine NTX
Urine CTX
Eye inflammation --> uveitis and scleritis
```
73
Associated with uveitis and scleritis with first time users
Bisphosphonates
74
Indicated for osteoporosis and Paget's Disease (bone overgrowth)
Alendronate
75
Bisphosphonate with the most GI side effects
Alendronate
| Dyspepsia, abdominal pain, acid reflux, constipation, diarrhea, musculoskeletal pain, nausea
76
Bisphosphate Black Box
Thigh or groin pain requires X Ray to look for atypical trochanteric fracture
77
Associated with osteonecrosis of the jaw
Bisphosphonates, specifically alendronate and zoledronic acid
78
Zoledronate ADRs
Flu-like infusion reactions with first dose
79
Indicated for hypercalcemia of malignancy, multiple myeloma and bone mets
Zoledronic Acid
80
Organ of concern with zoledronate acid
Kidneys
| Monitor renal function, particularly in patients > 65
81
Raloxifene ADRs
Increased risk of DVTs, increased vasomotor symptom (hot flashes), stroke risk
82
Helps build bone by stimulating osteoblast activity
Teriparatide (Forteo)
83
Teriparatide Black Box
Osteosarcoma
| Don't want to give this to anyone that has had skeletal malignancies or has had prior radiation
84
Teriparatide CI
Paget's disease, pregnant/nursing, pediatrics/young adults, prior radiation therapy, bone mets, skeletal malignancies, hypercalcemia
85
Teriparatide Patient Education
Have to carry it, have to keep it cold
86
Teriparatide ADRs
Transient and persistent hypercalcemia, headache, transient myalgia/arthralgia
87
Indicated for treatment of postmenopausal women with osteoporosis at high risk for fracture
Abaloparatide
| Denosumab
88
Abaloparatide Warnings
Osteosarcoma, orthostasis, hypercalcemia, hypercalciuria, urolithiasis
89
Abaloparatide ADRs
Hypercalciuria, dizziness, nausea, HA, palpitations, fatigue, upper abdominal pain, vertigo
90
Indicated for unresectable giant cell tumor of bone in adults and skeletally mature adolescents, increase bone mass
Denosumab
91
Denosumab ADRs
Cellulitis, eczema, flatulence, fatigue, asthenia, hypophosphatemia, nausea, dyspnea, arthralgia, headache
92
Denosumab Warnings
Hypocalcemia, ONJ, rash, infection, atypical fracture
| similar warnings to bisphosphonates
93
First-line for osteoporosis
Alendronate
Risedronate
Zoledronic acid
Denosumab
94
_______ should be used in patients with very high fracture risk or patients in whom bisphosphonate therapy failed
Teriparatide
95
Bisphosphonate Drug Holiday
If on for 5 years and bone density improves can take off a few years
96
Depression Symptom Mnemonic
```
SIGECAPS
Sleep Disorder
Lack of interest
Guilt
Energy
Concentration
Appetite
Psychomotor retardation or agitation
Suicidality
```
97
Black Box warning for all antidepressants
Suicidality in patients under age 24
98
Best tolerated, best efficacy antidepressant in kids
Fluoxetine
99
Symptoms of serotonin syndrome
Mental status changes, agitation, hallucinations, coma, autonomic instability, tachycardia, HTN, hyperthermia, hyperreflexia, incoordination, tremor, GI symptoms, ocular clonus, mydriasis
100
SSRI Warning
Increased bleed risk
| Intracranial hemorrhage, GI bleed
101
Block presynaptic serotonin transporter; blocks it from being taken up at the synaptic cleft
SSRIs
102
SSRI ADRs
N/V, insomnia, somnolence, weight gain, headache, bruxism, erectile dysfunction, decreased libido, diaphoresis, orthostasis, akathisia, osteopenia, GI bleed
103
Indicated for social anxiety disorder
Paroxetine
Sertraline
Venlafaxine
104
Indicated for PTSD
Fluoxetine, sertraline, venlafaxine
105
Indicated for neuropathic pain
Venlafaxine
Duloxetine
Tricyclics (Amitriptyline, Doxepin, Imipramine, Desipramine)
106
Indicated for fibromyalgia
Milnacipran
| Duloxetine
107
Indicated for migraine prophylaxis
Tricyclics (Amitriptyline, Doxepin, Imipramine, Desipramine)
108
Indicated for irritability associated with autistic disorder in children
Aripiprazole
| Risperidone
109
Indicated for agitation of acute tx
Aripiprazole
| Olanzapine (agitation associated with schizophrenia and bipolar)
110
Indicated for schizoaffective disorder
Paliperidone
111
Indicated for tardive dyskinesia
Valbenazine
112
Indicated for OCD
```
SSRIs: First Line
Fluoxetine
Paroxetine
Sertraline
Tricyclics (Amitriptyline, Doxepin, Imipramine, Desipramine)
```
113
Indicated for bulimia
Fluoxetine
114
Indicated for Parkinson's Disease
Fluoxetine
Sertraline
Venlafaxine
115
Indicated for Post-Menopausal Depressive Disorder
Sertraline
116
Indicated for hot flashes
Venlafaxine
117
Fluoxetine Patient Instructions
Take in the morning, can be activating/energizing
118
SSRI with least weight gain
Fluoxetine
119
Major indications for Paroxetine
Anxiety disorders
120
Most sedating, weight gain, sexual dysfunction, anticholinergic SSRI (could be helpful for patients whose depression is resulting in insomnia)
Paroxetine
121
SSRI that benefits in patients with depression and CV disease
Sertraline
122
Sertraline ADRs
Dry mouth, sedation, insomnia, tremor, dizziness, sexual dysfunction
123
Escitalopram ADRs
Nausea, sedation, insomnia, sexual side effects
124
SSRI preferred for erectile dysfunction patients
Citalopram (lowest risk of sexual side effects)
125
SSRI with risk of QT prolongation
Citalopram
126
Indication for Vortioxetine
Major depressive disorder
127
Vortioxetine ADRs
N/V, constipation
128
Drug interaction with SSRIs
Sumatriptan
| Increases risk of serotonin syndrome
129
SNRI ADRs
HTN, hyperlipidemia, dry mouth, HA, sexual dysfunction, insomnia/sedation, N/V, akathisia, diaphoresis, weight change
130
SNRI Drug Interactions
MAOIS, platelet inhibitors, levomilnacipran, vortioxetine, duloxetine
131
Venlafaxine Drug Interactions
Triptans, tramadol, tryptophan, SSRIs, St. John's Wort, lithium, fentanyl
132
Need to watch for _____________ with SNRIs
Risk of bleeding
| SSRIs, NSAIDs, ASA, warfarin
133
Most common ADRs of venlafaxine
Nausea, headache, somnolence, dry mouth, dizziness, insomnia, sexual dysfunction, sweating
134
Indication for Desvenlafaxine
Major depressive disorder
135
Organs to watch for Duloxetine
Kidneys and liver
| Avoid with liver or renal impairment
136
Duloxetine Drug Interactions
MAOIs
137
Duloxetine warnings
Orthostasis, serotonin syndrome, bleeding, SJS, hyponatremia
138
Milnacipran Drug Interactions
Serotonin drugs, MAOIs
139
Milnacipran Warnings
HTN, tachycardia, bleeding, seizures, serotonin syndrome
140
Indication for Levomilnacipran
Major depressive disorder
141
Levomilnacipran Drug Interactions
Serotonin drugs, MAOIs, strong 3A4 inhibitors (ritonavir, clarithromycin, ketoconazole, cobicistat, etc.)
142
Indication for Mirtazapine
Major depressive disorder
143
Mirtazapine Warnings
Caution about driving
| Avoid EtOH and other CNS depressants
144
Mirtazapine ADRs
Sedation, somnolence, dizziness, orthostasis, weight gain, elevated cholesterol, elevated LFTs, agranulocytosis
145
Organ of concern with Mirtazapine
Liver (elevated LFTs)
146
Indicated for major depression disorder and smoking cessation
Bupropion
147
Bupropion CIs
Seizure disorder, eating disorder, withdrawal of alcohol or sedatives
148
Bupropion ADRs
Agitation, anxiety, insomnia, weight loss, psychosis, delusions, hallucinations, confusion, HTN, N/V, HA, dry mouth
149
MOA: direct alpha-adrenergic blockage, membrane stabilizing effect on the myocardium, SNRI
Tricyclics
150
Tricyclic Drug Interactions
SSRIs, MAOIs, anticholinergics, sympathomimetics, cimetidine
151
Tricyclic ADRs
Anticholinergic effects, arrhythmia, sexual dysfunction, fall risk, diaphoresis
152
Risks associated with Tricyclics
Overdose
Risk of fatality with intentional overdose 70%
Seizures, CV symptoms, CNS symptoms, etc.
153
Antidepressant associated with arrhythmias
Tricyclics
154
Antidepressants associated with hypertension
SNRIs, bupropion
155
Antidepressant associated with hypertensive crisis
MAOIs
156
Antidepressant associated with increased cholesterol
Mirtazapine
157
Antidepressants associated with orthostatic hypotension
Tricyclics, MAOIs
158
Antidepressants associated with anticholinergic symptoms (urinary hesitancy constipation, delirium, visual changes)
Tricyclics
159
Antidepressants associated with dry mouth
Tricyclics, SNRIs, bupropion
160
Antidepressants associated with headaches
SSRIs, SNRIs, bupropion
161
Antidepressants associated with myoclonus
Tricyclics, MAOIs
162
Antidepressants associated with seizures
Bupropion, Tricyclics
163
Antidepressants associated with arousal and erectile dysfunction
Tricyclics, SSRIs, SNRIs
164
5-HT modulator used off-label at low dose for sleep
Trazodone
165
Trazodone ADRs
Sedation, somnolence, HA, dizziness, dry mouth, orthostasis, long QT, arrhythmia, priapism
166
Vilazodone Drug Interactions
3A4 substrate
167
Vilazodone ADRs
Sedation, somnolence, HA, dizziness, dry mouth, long QT, arrhythmia, orthostasis, priapism
168
Last line for patients who have failed or not responded to other antidepressants
MAOIs
169
MAOIs CIs
HTN, CV disease, high tyramine food (HTN crisis)
170
MAOIs Drug Interactions
Other MAOIs, sympathomimetics, CNS depressants (narcotics, alcohol), antiHTN, diuretic, bupropion, dextromethorphan, excessive caffeine
171
MAOI ADRs
Serotonin syndrome, sexual dysfunction, myoclonus, orthostasis, HTN crisis, dizziness, drowsiness, constipation, dry mouth, weight gain
172
St. John's Wort interaction with digoxin, imatinib, irinotecan levels
Decreases drug levels
173
St. John's Wort interaction with OCP estrogen
Increases OCP estrogen metabolism
174
St. John's Wort ADRs
Insomnia (take in morning), vivid dreams, restlessness, anxiety, agitation, diarrhea, dry mouth, dizziness, headache, rash, hypoglycemia, paresthesia
175
First line options for depression treatment
SSRI, SNRI, bupropion, mirtazapine
176
How long should it take before depression treatment takes effect?
at least 4 weeks
177
Potential drug causes of anxiety
Bupropion, nicotine, clonidine, albuterol, prednisone, amphetamines, caffeine, pseudoephedrine, levothyroxine
178
Secondary depression anxiety with thyroid disease
Hyperthyroid --> anxiety
| Hypothyroid --> depression
179
Binds to gamma subunit of GABA-A receptor in addition to GABA. Facilitates inhibitory effect of GABA, gives you more STOP messages
Benzodiazepines
180
Benzodiazepines ADRs
Lipophilicity, sedation, confusion, disorientation, memory impairment, ataxia, psychomotor impairment, euphoria, excitment, unpleasant feeling of loss of control, irritability, aggression, respiratory depression, hypotension
181
CIV Medications
Benzodiazepines
Zolpidem
Suvorexant
182
Symptoms of BDZ withdrawal
Follows abrupt discontinuation
| Insomnia, restlessness, muscle tension, irritability
183
Specifically indicated for anxiety, no effect on depression
Buspirone
184
First line for anxiety treatment
SSRIs, SNRIs, pregabalin
| Venlafaxine, duloxetine, paroxetine, escitalopram
185
Last line for anxiety treatment
Benzodiazepines
186
Induces state of mental indifference in patients (sedation without narcosis); given to patients with mania
Chlorpromazine
187
D2 receptor antagonists, 5-HT2c receptor antagonist, alpha 1 antagonist, H1 antagonist, M1 antagonist
1st generation antipsychotics
188
First generation antipsychotics ADRs
Weight gain, abnormal involuntary movements, akathisia, dystonia, dyskinesia, pseudoparkinsonism, sedation, anticholinergic effects
189
Monitoring for first generation antipsychotics
Prolactin levels (can be increased)
190
Schizophrenia Treatment
Aripiprazole, Asenapine, Clozapine, Iloperidone, Olanzapine, Paliperidone, Quetiapine, Risperidone, Ziprasidone
191
First drug to treat tardive dyskinesia
Valbenazine
192
How long does valbenazine take to decrease TD severity?
6 weeks
193
Valbenazine ADRs
Somnolence, balance disorders, falls, HA, akathisia, N/V, arthralgia
194
Antipsychotic Black Box
Increased mortality in elderly patients with dementia-releated psychosis
195
Clozapine Risk
Increased risk of agranulocytosis
| Baseline WBC, then weekly x 6 months, then q2 weeks for remainder of tx and 4 weeks after d/c
196
Clozapine Warnings
Myocarditis, orthostasis, bradycardia, lowered seizure threshold
197
Clozapine Drug Interactions
Smoking, Ciprofloxacin, strong 3A4 inducers
198
Iloperidone ADRs
Dizziness, somnolence, tachycardia, nausea, dry mouth, impaired thinking, judgment, motor skills, long QT, NMS, tardive dyskinesia, orthostasis, hyperprolactinemia, priapism
199
Paliperidone ADRs
Headache, tachycardia, somnolence, anxiety, akathisia, EPS
200
Can be used as monotherapy or adjunctive therapy with either lithium or valproate for bipolar I disorder
Asenapine
201
Asenapine ADRs
Insomnia, somnolence, N/V, anxiety, agitation, HA, constipation, psychosis
202
Brexpiprazole Warnings
Increased mortality and CVA in elderly dementia patients with psychosis, tardive dyskinesia, NMS
203
Brexpiprazole ADRs
Hyperglycemia, hyperlipidemia, weight gain, blood dyscrasias, akathisia, somnolence, anxiety, restlessness
204
First line for manic episodes of bipolar disorder, first line for maintenance treatment for bipolar disorder
Lithium
205
Lithium CIs
Renal or cardiovascular disease, severe debilitation, dehydration or sodium depletion, patients receiving diuretics
206
Organ of concern with lithium
```
Kidneys
Renal toxicity
Nephrogenic DI
Glomerular and interstitial fibrosis
Baseline sCr and U/A
```
207
Lithium toxicity symptoms
Diarrhea, vomiting, drowsiness, muscle weakness, lack of coordination (early symptoms)
208
Associated with unmasking of Brugada Syndrome
Lithium
Abnormal ECG findings
Afib, fever, nightmares, syncope, risk of sudden death
209
CII Medications
Stimulants for ADHD
210
Stimulant Warnings
sudden death, CVA and MI, psychosis exacerbation, growth suppression, peripheral vasculopathy (Raynaud's)
211
Stimulant Contraindications
MAOIs, anxiety, agitation
212
Stimulant ADRs
Insomnia, decreased appetite, weight loss, hypertension, arrhythmia, anxiety, panic, agitation
213
Atomoxetine Warnings
Increased risk of suicidal ideation in children and adolescents, CV events, increased BP, HR, liver injury, psychosis, urinary retention, priapism
214
Atomoxetine ADRs
N/V, decreased appetite, fatigue, somnolence, constipation, dry mouth, insomnia, erectile dysfunction, urinary hesitation, urinary retention, dysuria, dysmenorrhea, flushing
215
Atomoxetine Drug Interactions
2D6 inhibitors, MAOIs, albuterol
216
First line treatment for pediatric ADHD
Behavioral therapy, stimulants
217
First line treatment for adult ADHD
Stimulants
218
Second line treatment for pediatric ADHD
Atomoxetine
219
Second line treatment for adult ADHD
antidepressants
220
First line treatment for short term tx of insomnia
BDZ (Temazepam, Triazolam)
221
Zolpidem ADRs
Rebound insomnia, drowsiness, dizziness, allergic rxn, angioedema, dry mouth, abdominal pain, HA, sleep driving, sleep eating, abnormal thinking
222
Zolpidem patient education
Next day impairment
223
Eszopiclone patient education
Only dose when patients have at least 7-8 hours to sleep
224
Eszopiclone ADRs
Unpleasant taste, HA, infection, next day impairment, parasomnias, anaphylaxis, angioedema
225
Can be taken upon nocturnal awakening if patient has 4 hours left to sleep
Zaleplon
226
Zaleplon ADRs
HA, dizziness, somnolence, complex behaviors, anaphylaxis
227
Melatonin ADRs
Daytime drowsiness, HA, dizziness
228
Melatonin Drug Interactions
Potentiates anticoagulants, inhibits AEDs, decreased BP, increased hyperglycemia
229
Which sleep aid is associated with increased hyperglycemia?
Melatonin
230
Organ of concern for Ramelteon
Liver
| Avoid in patients with liver problems
231
First treatment for non-24 hour sleep-wake disorder
Tasimelteon
232
Tasimelteon ADRs
Somnolence, HA, increased LFT, nightmares, unusual dreams, URI, UTI
233
Tasimelteon Drug Interactions
Strong CYP1A2 inhibitors, strong CYP3A4 inducers
234
Orexin receptor antagonist; suppresses wake drive
Suvorexant
235
Suvorexant CIs
Narcolepsy
236
Suvorexant ADRs
Next-day impairment, complex behaviors, depression, decreased respiratory function, hallucinations, sleep paralysis
237
Antidepressant sleep aid
Doxepin
238
Valerian Root ADRs
HA, GI upset, mental dullness, excitability, uneasiness, cardiac disturbances, insomnia
239
Organ of concern for Valerian Root
Liver
| Hepatotoxicity
